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Making healthy choices easy choices: the role of empowerment

European Journal of Clinical Nutrition volume 59, pages S10–S16 (2005)Cite this article

Abstract

An important goal of health promotion is to make it easier for people to make healthy choices. However, this may be difficult if people do not feel control over their environment and their personal circumstances. An important concept in relation to this is empowerment. Health professionals are expected to facilitate and enable people moving towards empowerment. In this paper, we address the question what is meant by individual empowerment. In an attempt to provide a theoretical framework, we discuss individual empowerment from a salutogenic perspective. This perspective introduces two fundamental concepts: the general resistance resources, and the sense of coherence. In addition, in order to further clarify and operationalise the concept, some factors influencing individual empowerment are identified, that is, locus of control, learned helplessness, self-efficacy and outcome expectations. These concepts find common ground in feelings of (lack of) control, but they differ in stability and changeability. We provide some suggestions how these factors can be influenced, and we discuss the meaning of the identified factors for empowering interactions between professionals and their clients. Health professionals can facilitate people to see a correspondence between their efforts and the outcomes thereof, improve and facilitate health literacy, in a relationship which can be characterised as partnership.

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Authors and Affiliations

  1. Sub-department Communication Science, Wageningen University, Wageningen, The Netherlands

    M A Koelen

  2. Nordic School of Public Health, Gotenborg, Sweden

    B Lindström

Authors
  1. M A Koelen
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  2. B Lindström
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Correspondence to M A Koelen.

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Abbreviated Discussion after Koelen

Rosser: In family practice, and probably in medicine at large, there is a concept that what happens between the physician and the patient is described as a partnership, where the physician is the expert, but the patient brings his own knowledge of his life; his beliefs, his values. So both partners have a set of knowledge. And you have to bring the two together to get empowerment ….

Koelen: The patient is the expert of his own beliefs.

Rosser: That is correct. The physician or health care worker does not have that expertise. If they ignore that piece of the two things having to come together then it will not be very effective.

Koelen: In the recent UK white paper, for instance ‘Making healthy choices easy choices’, the first thing is that it is the individual who is responsible for his own health and behaviour. At the same time, the individual cannot be held responsible for something that is out of his control.

Kok: You said in your talk that through interaction and communication the situation may be improved. Could you be a little bit more specific?

Koelen: I said this about partnerships. It's about taking each other seriously…. Not only being diagnostic and prescribing something. But talk with the patient more broadly about their situation. For example, doctors seem to have trouble with motivating patients to lose weight. For a doctor it may be very helpful to know why this is.

Green: In my experience the word empowerment does not travel so well in certain circles. The term self-efficacy communicates about the same thing. What in your mind is the essential difference?

Koelen: Empowerment is something more enduring. Self-efficacy is a part of empowerment. So empowered people will have higher levels of self-efficacy. Self-efficacy is more related to a certain type of experience or behaviour. I can feel very effective in changing my diet but not in my ability to take up physical exercise. A lot of success experience can lead to higher feelings of self-efficacy and to the opposite of learned helplessness, and that is learned hopefulness.

Truswell: There is a relation between someone's position in society and his feelings of empowerment. There must be a lot of people in our societies who have no control over their own lives, while others have a lot of control.

Koelen: That is true, and this affects the learned helplessness.

Helman: Whether the concept of learned helplessness applies to the family physician needs to be explored. In my experience they are quite willing to refer the patient to the dietician, who seems to be quite optimistic on their possibility to help the patient lose weight. Perhaps they don't observe the obstacles so much. Can we do something to change the attitude of family physicians?

Koelen: General physicians are people. So everything we say about patients will also apply to GPs. So, we could learn a lot from social science.

Rosser: A colleague of mine wrote an article in the Canadian Family Physician that family physicians suffer from learned helplessness professionally; not just in diet counselling, but basically that they were conditioned in medical school that specialists were the ones to look after most conditions, and therefore they should refer everybody that had anything more than a minor condition, and also that they do not really need to research or understand what they do, because it's all done by somebody else. This is something to remember when empowering family physicians to take on health promotion.

Van Weel: Do you think people who feel empowered have a more healthy life? Our government strongly believes that if you make patients responsible for their own health you will reduce health costs.

Koelen: People who are more empowered do not necessarily behave more healthily….. People who are more empowered can take better control over their own life. But this can be in a more healthy way or in a less healthy way.

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Koelen, M., Lindström, B. Making healthy choices easy choices: the role of empowerment. Eur J Clin Nutr 59 (Suppl 1), S10–S16 (2005). https://doi.org/10.1038/sj.ejcn.1602168

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